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Tracheostomy in high-risk patients on ECMO: A bedside hybrid dilational technique utilizing a rummel tourniquet 使用 ECMO 的高危患者的气管切开术:利用鲁梅尔止血带的床旁混合扩张技术
IF 1.4 Q3 Medicine Pub Date : 2024-03-24 DOI: 10.1016/j.sopen.2024.03.004
Mark Falimirski
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引用次数: 0
Association of substance-use disorder with outcomes of major elective abdominal operations: A contemporary national analysis 药物滥用障碍与腹部大手术结果的关系:当代国家分析
IF 1.4 Q3 Medicine Pub Date : 2024-03-22 DOI: 10.1016/j.sopen.2024.03.006
Baran Khoraminejad , Sara Sakowitz MS MPH , Zihan Gao MHSc , Nikhil Chervu MD , Joanna Curry BA , Konmal Ali , Syed Shahyan Bakhtiyar MD MBE , Peyman Benharash MD MS

Background

Affecting >20million people in the U.S., including 4 % of all hospitalized patients, substance use disorder (SUD) represents a growing public health crisis. Evaluating a national cohort, we aimed to characterize the association of concurrent SUD with perioperative outcomes and resource utilization following elective abdominal operations.

Methods

All adult hospitalizations entailing elective colectomy, gastrectomy, esophagectomy, hepatectomy, and pancreatectomy were tabulated from the 2016–2020 National Inpatient Sample. Patients with concurrent substance use disorder, comprising alcohol, opioid, marijuana, sedative, cocaine, inhalant, hallucinogen, or other psychoactive/stimulant use, were considered the SUD cohort (others: nSUD). Multivariable regression models were constructed to evaluate the independent association between SUD and key outcomes.

Results

Of ∼1,088,145 patients, 32,865 (3.0 %) comprised the SUD cohort. On average, SUD patients were younger, more commonly male, of lowest quartile income, and of Black race. SUD patients less frequently underwent colectomy, but more often pancreatectomy, relative to nSUD.

Following risk adjustment and with nSUD as reference, SUD demonstrated similar likelihood of in-hospital mortality, but remained associated with increased odds of any perioperative complication (Adjusted Odds Ratio [AOR] 1.17, CI 1.09–1.25). Further, SUD was linked with incremental increases in adjusted length of stay (β + 0.90 days, CI +0.68–1.12) and costs (β + $3630, CI +2650–4610), as well as greater likelihood of non-home discharge (AOR 1.54, CI 1.40–1.70).

Conclusions

Concurrent substance use disorder was associated with increased complications, resource utilization, and non-home discharge following major elective abdominal operations. Novel interventions are warranted to address increased risk among this vulnerable population and address significant disparities in postoperative outcomes.

背景美国有 2,000 万人受到药物使用障碍(SUD)的影响,占住院患者总数的 4%,这是一个日益严重的公共卫生危机。我们评估了一个全国性队列,旨在描述择期腹部手术后并发 SUD 与围手术期结果和资源利用的关系。方法从 2016-2020 年全国住院病人样本中统计了所有需要进行择期结肠切除术、胃切除术、食管切除术、肝切除术和胰切除术的成人住院病人。同时患有药物使用障碍(包括酒精、阿片类药物、大麻、镇静剂、可卡因、吸入剂、致幻剂或其他精神活性剂/兴奋剂的使用)的患者被视为SUD队列(其他:nSUD)。结果 在 1,088,145 名患者中,有 32,865 人(3.0%)属于 SUD 群体。SUD 患者平均年龄较轻,多为男性,收入处于最低四分位数,且为黑人。在进行风险调整并以 nSUD 作为参照后,SUD 显示出相似的院内死亡率,但仍与围手术期并发症几率的增加有关(调整后比值比 [AOR] 1.17,CI 1.09-1.25)。此外,药物滥用与调整后住院时间(β + 0.90 天,CI +0.68-1.12)和费用(β + 3630 美元,CI +2650-4610)的递增以及非居家出院可能性的增加有关(AOR 1.54,CI 1.40-1.70)。需要采取新的干预措施来应对这一弱势群体的风险增加,并解决术后结果的显著差异。
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引用次数: 0
HPB ultrasound guidance techniques - Targeting HPB 超声引导技术 - 定位
IF 1.4 Q3 Medicine Pub Date : 2024-03-13 DOI: 10.1016/j.sopen.2024.02.013
Matthew S. Strand, David A. Iannitti

Ultrasound is an indispensable tool for intraoperative assessment and treatment of hepatopancreatobiliary pathology. As minimally invasive approaches to HPB surgery continue to expand and the benefits of parenchymal-sparing liver surgery are increasingly appreciated, skillful targeting will play an even bigger role in HPB surgical practice. Techniques for intraoperative targeting of liver lesions for the purposes of biopsy and ablation, particularly in the laparoscopic setting, are the focus of this chapter.

Current evidence supports the use of ablation for a variety of liver lesions including hepatocellular carcinoma and metastatic colorectal cancer, particularly for smaller lesions.

Successful targeting requires optimization of patient position and port placement. When targeting multiple lesions, thoughtful treatment sequencing is critical to maintaining visualization and optimizing outcomes.

超声波是术中评估和治疗肝胆胰病理不可或缺的工具。随着肝胆胰外科微创方法的不断扩大,以及人们越来越重视保肝手术的益处,娴熟的定位技术将在肝胆胰外科实践中发挥更大的作用。目前的证据支持对包括肝细胞癌和转移性结肠直肠癌在内的多种肝脏病变进行消融治疗,尤其是对较小的病变,成功的靶向治疗需要优化患者体位和端口放置。在针对多个病灶进行治疗时,周到的治疗排序对于保持可视化和优化治疗效果至关重要。
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引用次数: 0
Editorial Board Page 编辑委员会页面
IF 1.4 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/S2589-8450(24)00043-5
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引用次数: 0
Trends, outcomes, and factors associated with in-hospital opioid overdose following major surgery 大手术后院内阿片类药物过量的趋势、结果和相关因素
IF 1.4 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.sopen.2024.03.002
Joanna Curry , Troy Coaston , Amulya Vadlakonda , Sara Sakowitz , Saad Mallick , Nikhil Chervu , Baran Khoraminejad , Peyman Benharash

Background

With the growing opioid epidemic across the US, in-hospital utilization of opioids has garnered increasing attention. Using a national cohort, this study sought to characterize trends, outcomes, and factors associated with in-hospital opioid overdose (OD) following major elective operations.

Methods

We identified all adult (≥18 years) hospitalizations entailing select elective procedures in the 2016–2020 National Inpatient Sample. Patients who experienced in-hospital opioid overdose were characterized as OD (others: Non-OD). The primary outcome of interest was in-hospital OD. Multivariable logistic and linear regression models were developed to evaluate the association between in-hospital OD and mortality, length of stay (LOS), hospitalization costs, and non-home discharge.

Results

Of an estimated 11,096,064 hospitalizations meeting study criteria, 5375 (0.05 %) experienced a perioperative OD. Compared to others, OD were older (66 [57–73] vs 64 [54–72] years, p < 0.001), more commonly female (66.3 vs 56.7 %, p < 0.001), and in the lowest income quartile (26.4 vs 23.2 %, p < 0.001). After adjustment, female sex (Adjusted Odds Ratio [AOR] 1.68, 95 % Confidence Interval [CI] 1.47–1.91, p < 0.001), White race (AOR 1.19, CI 1.01–1.42, p = 0.04), and history of substance use disorder (AOR 2.51, CI 1.87–3.37, p < 0.001) were associated with greater likelihood of OD. Finally, OD was associated with increased LOS (β +1.91 days, CI [1.60–2.21], p < 0.001), hospitalization costs (β +$7500, CI [5900–9100], p < 0.001), and greater odds of non-home discharge (AOR 2.00, CI 1.61–2.48, p < 0.001).

Conclusion

Perioperative OD remains a rare but costly complication after elective surgery. While pain control remains a priority postoperatively, protocols and recovery pathways must be re-examined to ensure patient safety.

背景随着阿片类药物在美国日益流行,阿片类药物的院内使用也越来越受到关注。本研究利用全国性队列,试图描述重大择期手术后院内阿片类药物过量(OD)的趋势、结果和相关因素。院内阿片类药物过量的患者被定性为OD(其他:非OD)。主要研究结果为院内阿片类药物过量。我们建立了多变量逻辑回归和线性回归模型,以评估院内 OD 与死亡率、住院时间(LOS)、住院费用和非家庭出院之间的关系。与其他人相比,OD 的年龄更大(66 [57-73] 岁 vs 64 [54-72] 岁,p < 0.001),更常见的是女性(66.3 vs 56.7 %,p < 0.001)和最低收入四分位数(26.4 vs 23.2 %,p < 0.001)。经调整后,女性性别(调整比值比 [AOR] 1.68,95% 置信区间 [CI] 1.47-1.91,p <0.001)、白种人(AOR 1.19,CI 1.01-1.42,p = 0.04)和药物使用障碍史(AOR 2.51,CI 1.87-3.37,p <0.001)与发生 OD 的可能性增加有关。最后,OD 与 LOS 增加(β +1.91 天,CI [1.60-2.21],p <0.001)、住院费用增加(β +$7500, CI [5900-9100],p <0.001)和非家庭出院几率增加(AOR 2.00, CI 1.61-2.48,p <0.001)有关。虽然疼痛控制仍是术后的首要任务,但必须重新审查规程和恢复路径,以确保患者安全。
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引用次数: 0
Correlation between research productivity during and after orthopaedic surgery training 矫形外科培训期间和培训结束后的研究成果之间的相关性
IF 1.4 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.sopen.2024.02.010
Daniel Acevedo , Henson Destiné , Christopher J. Murdock , Dawn LaPorte , Amiethab A. Aiyer

Background

Research experience is mandatory for all Orthopaedic Surgery residency programs. Although the allocation of required protected time and resources varies from program to program, the underlying importance of research remains consistent with mutual benefit to both residents and the program and faculty. Authorship and publications have become the standard metric used to evaluate academic success. This study aimed to determine if there is a correlation between the research productivity of Orthopaedic Surgery trainees and their subsequent research productivity as attending Orthopaedic Surgeons.

Methods

Using the University of Mississippi Orthopaedic Residency Program Research Productivity Rank List, 30 different Orthopaedic Surgery Residency Programs were analyzed for the names of every graduating surgeon in their 2013 class. PubMed Central was used to screen all 156 physicians and collect all publications produced by them between 2008 and August 2022. Results were separated into two categories: Publications during training and Publications post-training.

Results

As defined above, 156 Surgeons were analyzed for publications during training and post-training. The mean number of publications was 7.02 ± 17.819 post-training vs. 2.47 ± 4.313 during training, P < 0.001. The range of publication post-training was 0–124 vs. 0–30 during training. Pearson correlation between the two groups resulted in a value of 0.654, P < 0.001.

Conclusion

Higher research productivity while training correlates to higher productivity post-training, but overall Orthopaedic surgeons produce more research after training than during. With the growing importance of research, more mentorship, time, and resources must be dedicated to research to instill and foster greater participation while in training.

背景研究经历是所有骨科住院医师培训项目的必修课程。尽管各项目分配的所需保护时间和资源各不相同,但研究的根本重要性始终如一,对住院医师、项目和教师都是互惠互利的。作者身份和出版物已成为评估学术成就的标准指标。本研究旨在确定矫形外科受训者的研究生产率与他们作为矫形外科主治医师的后续研究生产率之间是否存在关联。方法利用密西西比大学矫形外科住院医师项目研究生产率排名表,分析了 30 个不同的矫形外科住院医师项目,以了解其 2013 届毕业的每一位外科医生的姓名。利用 PubMed Central 筛选了所有 156 名医生,并收集了他们在 2008 年至 2022 年 8 月期间发表的所有论文。结果分为两类:结果如上所述,对 156 名外科医生在培训期间和培训后发表的论文进行了分析。培训后发表论文的平均数量为 7.02 ± 17.819 篇,培训期间为 2.47 ± 4.313 篇,P < 0.001。培训后发表论文的范围为 0-124 篇,而培训期间为 0-30 篇。两组之间的 Pearson 相关性值为 0.654,P <0.001。结论培训期间的研究生产率越高,培训后的生产率也越高,但总体而言,骨科外科医生在培训后的研究成果要多于培训期间。随着研究的重要性与日俱增,必须为研究提供更多的指导、时间和资源,以灌输和促进在培训期间更多地参与研究。
{"title":"Correlation between research productivity during and after orthopaedic surgery training","authors":"Daniel Acevedo ,&nbsp;Henson Destiné ,&nbsp;Christopher J. Murdock ,&nbsp;Dawn LaPorte ,&nbsp;Amiethab A. Aiyer","doi":"10.1016/j.sopen.2024.02.010","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.02.010","url":null,"abstract":"<div><h3>Background</h3><p>Research experience is mandatory for all Orthopaedic Surgery residency programs. Although the allocation of required protected time and resources varies from program to program, the underlying importance of research remains consistent with mutual benefit to both residents and the program and faculty. Authorship and publications have become the standard metric used to evaluate academic success. This study aimed to determine if there is a correlation between the research productivity of Orthopaedic Surgery trainees and their subsequent research productivity as attending Orthopaedic Surgeons.</p></div><div><h3>Methods</h3><p>Using the University of Mississippi Orthopaedic Residency Program Research Productivity Rank List, 30 different Orthopaedic Surgery Residency Programs were analyzed for the names of every graduating surgeon in their 2013 class. PubMed Central was used to screen all 156 physicians and collect all publications produced by them between 2008 and August 2022. Results were separated into two categories: Publications during training and Publications post-training.</p></div><div><h3>Results</h3><p>As defined above, 156 Surgeons were analyzed for publications during training and post-training. The mean number of publications was 7.02 ± 17.819 post-training vs. 2.47 ± 4.313 during training, <em>P</em> &lt; 0.001. The range of publication post-training was 0–124 vs. 0–30 during training. Pearson correlation between the two groups resulted in a value of 0.654, <em>P</em> &lt; 0.001.</p></div><div><h3>Conclusion</h3><p>Higher research productivity while training correlates to higher productivity post-training, but overall Orthopaedic surgeons produce more research after training than during. With the growing importance of research, more mentorship, time, and resources must be dedicated to research to instill and foster greater participation while in training.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000319/pdfft?md5=b9281ff5ba6df056798fbdcf7f5a1f91&pid=1-s2.0-S2589845024000319-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139992456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Enhanced recovery after surgery: Preoperative carbohydrate loading and insulin management in type 2 diabetes 加强术后恢复:2 型糖尿病患者术前碳水化合物负荷和胰岛素管理
IF 1.4 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.sopen.2024.02.012
Cindy Bredefeld DO, FACE, FNLA , Amy Patel MD , Shahidul Islam DrPH , Virginia Peragallo-Dittko RN, BC-ADM, CDCES, FADCES, FAAN

We assessed our institutional practice of individualized insulin dosing for patients with type 2 diabetes receiving preoperative carbohydrate loading (CHO-L) within an enhanced recovery after surgery (ERAS®) protocol. Patients enrolled in an ERAS® protocol with concomitant type 2 diabetes received rapid acting insulin (Novolog®[insulin aspart]) prior to 50 g CHO-L on the day of surgery. Following CHO-L and the administration of insulin, no hypoglycemic episodes occurred with preoperative POC glucose values between 6.8 and 12.3 mmol/L (123 and 221 mg/dL). Our experience demonstrates that administering rapid acting insulin prior to CHO-L in patients with type 2 diabetes is feasible and targets the potentially negative influence CHO-L may impose on preoperative glycemia in this population. Important considerations of this approach are highlighted and an insulin dosing algorithm designed for non-specialty providers is suggested.

我们评估了本机构在术后恢复强化方案(ERAS®)中为接受术前碳水化合物负荷(CHO-L)治疗的 2 型糖尿病患者个体化胰岛素剂量的做法。参加 ERAS® 方案并同时患有 2 型糖尿病的患者在手术当天接受 50 克 CHO-L 之前,先接受速效胰岛素(Novolog®[门冬胰岛素])。在注射 CHO-L 和胰岛素后,术前 POC 血糖值在 6.8 至 12.3 mmol/L 之间(123 至 221 mg/dL)的患者没有发生低血糖。我们的经验表明,在 2 型糖尿病患者使用 CHO-L 前注射速效胰岛素是可行的,而且可以消除 CHO-L 对这类人群术前血糖可能造成的负面影响。我们强调了这种方法的重要注意事项,并为非专科医生提供了胰岛素剂量算法。
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引用次数: 0
The continued financial effect of COVID: Increasing costs for non-elective major lower extremity amputations COVID 的持续财务影响:非选择性主要下肢截肢的成本增加
IF 1.4 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.sopen.2024.03.001
Johnathan V. Torikashvili , Meagan D. Read , Haroon M. Janjua , Rajavi Parikh , Paul C. Kuo , Emily A. Grimsley

Background

The COVID-19 pandemic necessitated changes in processes of care, which significantly impacted surgical care. This study evaluated the impact of these changes on patient outcomes and costs for non-elective major lower extremity amputations (LEA).

Methods

The 2019–2021 Florida Agency for Health Care Administration database was queried for adult patients who underwent non-elective major LEA. Per-patient inflation-adjusted costs were collected. Patient cohorts were established based on Florida COVID-19 mortality rates: COVID-heavy (CH) included nine months with the highest mortality, COVID-light (CL) included nine months with the lowest mortality, and pre-COVID (PC) included nine months before COVID (2019). Outcomes included in-hospital patient outcomes and hospitalization cost.

Results

6132 patients were included (1957 PC, 2104 CH, and 2071 CL). Compared to PC, there was increased patient acuity at presentation, but morbidity (31%), mortality (4%), and length of stay (median 12 [8–17] days) were unchanged during CH and CL. Additionally, costs significantly increased during the pandemic; median total cost rose 9%, room costs increased by 16%, ICU costs rose by 15%, and operating room costs rose by 15%. When COVID-positive patients were excluded, cost of care was still significantly higher during CH and CL.

Conclusions

Despite maintaining pre-pandemic standards, as evidenced by unchanged outcomes, the pandemic led to increased costs for patients undergoing non-elective major LEA. This was likely due to increased patient acuity, resource strain, and supply chain shortages during the pandemic.

Key message

While patient outcomes for non-elective major lower extremity amputations remained consistent during the COVID-19 pandemic, healthcare costs significantly increased, likely due to increased patient acuity and heightened pressures on resources and supply chains. These findings underscore the need for informed policy changes to mitigate the financial impact on patients and healthcare systems for future public health emergencies.

背景COVID-19大流行导致护理流程必须改变,这对外科护理产生了重大影响。本研究评估了这些变化对非选择性主要下肢截肢(LEA)的患者预后和成本的影响。方法查询了 2019-2021 年佛罗里达州医疗保健管理机构数据库中接受非选择性主要 LEA 的成年患者。收集了每名患者经通货膨胀调整后的成本。根据佛罗里达州 COVID-19 死亡率建立了患者队列:COVID重度(CH)包括死亡率最高的九个月,COVID轻度(CL)包括死亡率最低的九个月,COVID前(PC)包括COVID(2019)之前的九个月。结果包括院内患者预后和住院费用。结果共纳入 6132 例患者(1957 例 PC、2104 例 CH 和 2071 例 CL)。与 PC 相比,患者发病时的严重程度有所增加,但 CH 和 CL 期间的发病率(31%)、死亡率(4%)和住院时间(中位数 12 [8-17] 天)均保持不变。此外,大流行期间的费用明显增加;总费用中位数增加了 9%,病房费用增加了 16%,重症监护室费用增加了 15%,手术室费用增加了 15%。排除 COVID 阳性患者后,CH 和 CL 期间的护理成本仍显著较高。结论尽管大流行前的标准保持不变,结果也证明了这一点,但大流行导致接受非选择性大型 LEA 的患者成本增加。关键信息在 COVID-19 大流行期间,虽然非选择性主要下肢截肢手术的患者治疗效果保持不变,但医疗成本却显著增加,这可能是由于患者急诊率增加、资源和供应链压力增大所致。这些发现突出表明,在未来的公共卫生突发事件中,有必要对政策进行知情调整,以减轻对患者和医疗系统的经济影响。
{"title":"The continued financial effect of COVID: Increasing costs for non-elective major lower extremity amputations","authors":"Johnathan V. Torikashvili ,&nbsp;Meagan D. Read ,&nbsp;Haroon M. Janjua ,&nbsp;Rajavi Parikh ,&nbsp;Paul C. Kuo ,&nbsp;Emily A. Grimsley","doi":"10.1016/j.sopen.2024.03.001","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.03.001","url":null,"abstract":"<div><h3>Background</h3><p>The COVID-19 pandemic necessitated changes in processes of care, which significantly impacted surgical care. This study evaluated the impact of these changes on patient outcomes and costs for non-elective major lower extremity amputations (LEA).</p></div><div><h3>Methods</h3><p>The 2019–2021 Florida Agency for Health Care Administration database was queried for adult patients who underwent non-elective major LEA. Per-patient inflation-adjusted costs were collected. Patient cohorts were established based on Florida COVID-19 mortality rates: COVID-heavy (CH) included nine months with the highest mortality, COVID-light (CL) included nine months with the lowest mortality, and pre-COVID (PC) included nine months before COVID (2019). Outcomes included in-hospital patient outcomes and hospitalization cost.</p></div><div><h3>Results</h3><p>6132 patients were included (1957 PC, 2104 CH, and 2071 CL). Compared to PC, there was increased patient acuity at presentation, but morbidity (31%), mortality (4%), and length of stay (median 12 [8–17] days) were unchanged during CH and CL. Additionally, costs significantly increased during the pandemic; median total cost rose 9%, room costs increased by 16%, ICU costs rose by 15%, and operating room costs rose by 15%. When COVID-positive patients were excluded, cost of care was still significantly higher during CH and CL.</p></div><div><h3>Conclusions</h3><p>Despite maintaining pre-pandemic standards, as evidenced by unchanged outcomes, the pandemic led to increased costs for patients undergoing non-elective major LEA. This was likely due to increased patient acuity, resource strain, and supply chain shortages during the pandemic.</p></div><div><h3>Key message</h3><p>While patient outcomes for non-elective major lower extremity amputations remained consistent during the COVID-19 pandemic, healthcare costs significantly increased, likely due to increased patient acuity and heightened pressures on resources and supply chains. These findings underscore the need for informed policy changes to mitigate the financial impact on patients and healthcare systems for future public health emergencies.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000332/pdfft?md5=e62c4f7e35d587358abf17653ffbcd8b&pid=1-s2.0-S2589845024000332-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140187414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ultrasound principles and instrumentation 超声原理和仪器
IF 1.4 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.sopen.2024.02.005
Catalina Poggi, Martin Palavecino

Ultrasound (US) is a fundamental and inexpensive tool both for the prompt diagnosis and for the study of diverse medical conditions. Its widespread use is partly due to the availability of US devices in the daily practice of physicians. US can be performed in real-time and is instrumental in the generation of clinical algorithms for the management of situations like trauma. It also constitutes a primary approach for the study of oncological diseases, and a guidance tool for interventions such as percutaneous drainages. In addition, and specifically for HPB surgeons, US is an essential tool in the operating room: intraoperative (either open or laparoscopic) US is necessary for the accurate determination of the stage, location, number, and margins of tumors within the liver, pancreas, or biliary tree. On another note, reading and understanding US images are skills that require time and training, which should be taught during surgical residencies. However, this is not customary in most residencies globally. This chapter offers a concise yet comprehensive elucidation of the basic principles of ultrasonography, the instruments required to perform an ultrasonic assessment of a patient, and the basic ultrasound controls.

超声波(US)是一种基本而廉价的工具,可用于迅速诊断和研究各种医疗状况。它之所以得到广泛应用,部分原因是医生在日常工作中可以使用超声设备。超声波检查可实时进行,有助于制定治疗创伤等情况的临床算法。它还是研究肿瘤疾病的主要方法,也是经皮引流等介入治疗的指导工具。此外,特别是对于 HPB 外科医生来说,US 是手术室中必不可少的工具:术中(开腹或腹腔镜)US 是准确确定肝脏、胰腺或胆管内肿瘤的分期、位置、数量和边缘所必需的。另一方面,阅读和理解 US 图像是需要时间和训练的技能,应该在外科住院医师培训期间教授。然而,这在全球大多数住院医师培训中并不常见。本章简明而全面地阐明了超声造影的基本原理、对患者进行超声评估所需的仪器以及基本的超声控制。
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引用次数: 0
Optimum management for complex anal fistula: A network meta-analysis of randomized controlled trials 复杂性肛瘘的最佳治疗方法:随机对照试验的网络荟萃分析
IF 1.4 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.sopen.2024.03.003
Warsinggih , Citra Aryanti , Muhammad Faruk

Background

Complex anal fistula has a high recurrence rate and disturbing surgical complications, which are frustrating for patients and challenging for surgeons. Although single or combined management methods have produced positive outcomes, no trials have simultaneously compared these therapies. Therefore, this study aimed to determine the management method for complex anal fistula with the lowest failure and complication rates.

Methods

This network meta-analysis (NMA) was registered in the international prospective register of systematic reviews (PROSPERO; CRD42023393349). Randomized controlled trials that analyzed complex anal fistula management were obtained from Medline, Scopus, and Cochrane using representative keywords. The primary outcome was the failure of anal fistulas to heal (including recurrences) after 6 to 12 months. The secondary outcome was fecal incontinence. All statistical analysis was conducted within the Bayesian framework using BUGSnet 1.1.0 in R Studio. A forest plot and league table were used to present the results.

Results

A total of 19 studies containing 15 interventions, 1844 subjects, and 104 pairwise comparisons were analyzed quantitatively. The lowest failure rates occurred with ligation of the intersphincteric fistula tract (LIFT) + Plug (RR 0.2; 95 % CI 0.01–2.65), LIFT + platelet-rich plasma (PRP) (RR 0.22; 95 % CI 0.01–2.89), and FSR (RR 0.26; 95 % CI 0.02–2.12) relative to drainage seton. LIFT combined with other management methods showed lower fecal incontinence rates than the other treatments.

Conclusion

The combination of LIFT with plug or PRP resulted in lower failure and complication rates in the management of complex anal fistula compared to the other methods tested.

背景复杂性肛瘘的复发率很高,手术并发症也令人不安,这让患者感到沮丧,也给外科医生带来了挑战。虽然单一或联合治疗方法取得了积极的效果,但还没有试验同时比较这些疗法。因此,本研究旨在确定失败率和并发症发生率最低的复杂性肛瘘治疗方法。方法本网络荟萃分析(NMA)在国际前瞻性系统综述注册中心(PROSPERO;CRD42023393349)注册。使用具有代表性的关键词从 Medline、Scopus 和 Cochrane 中获取了分析复杂肛瘘治疗的随机对照试验。主要结果是肛瘘在 6 至 12 个月后未能愈合(包括复发)。次要结果是大便失禁。所有统计分析均在贝叶斯框架内使用 R Studio 中的 BUGSnet 1.1.0 进行。结果 共对 19 项研究进行了定量分析,其中包括 15 种干预措施、1844 名受试者和 104 项配对比较。相对于引流套管,括约肌间瘘道结扎术(LIFT)+塞子(RR 0.2; 95 % CI 0.01-2.65)、LIFT+富血小板血浆(PRP)(RR 0.22; 95 % CI 0.01-2.89)和FSR(RR 0.26; 95 % CI 0.02-2.12)的失败率最低。结论在治疗复杂性肛瘘时,与其他测试方法相比,将 LIFT 与塞子或 PRP 结合使用可降低失败率和并发症发生率。
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Surgery open science
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